Abstract 11555: To Fax or Not to Fax, that is the Question: The Role of Faxing ECGs From the Emergency Department in the Diagnosis of STEMIs?
Background: Autonomous emergency physician STEMI diagnoses are an effective strategy for achieving timely reperfusion therapy. Nevertheless, emergent faxing of the ECG to the on-call cardiologist is common when the diagnosis remains in question. The implications of this practice on diagnostic accuracy and timeliness of reperfusion are unknown.
Methods: Data were analyzed from the Activate-SF registry of STEMI diagnoses at 2 urban primary PCI centers at UC San Francisco. The primary outcome was “false-positive” STEMI activation and a key secondary outcome was the impact on time sensitive STEMI performance measures. Multivariate logistic and linear regression models were used to evaluate ‘false-positive’ STEMI diagnosis and time sensitive STEMI performance measures, respectively.
Results: Of 412 total patients, 17% of all potential STEMIs had their ECG faxed to the on-call cardiology fellow. Faxing decreased the odds of a false-positive STEMI activation by 60% (multivariate adjusted OR 0.40, 95%CI 0.17-0.92, p=0.032). In unadjusted analyses there was a statistically significant increase in door-to-balloon time (minutes, mean ± SE, 167.8± 17.9 versus 90.9 ± 5.4, p<0.001 ). However, after adjustment for potential confounders, this contact was also associated with a 37% longer door-to-balloon time (95%CI 17-61, p<0.001).
Conclusions: Faxing the on-call cardiology fellow the 12-lead ECG remains a frequent practice when the diagnosis of a STEMI is in question. This process significantly decreases the odds of “false-positive” activation. However, this comes at a price of dramatically increasing the door-to-balloon time.
- © 2011 by American Heart Association, Inc.